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Corneal Collagen Cross-Linking for Keratoconus

Corneal collagen cross-linking (CXL) is currently the only treatment that may slow down the progression of keratoconus. It is a minimally invasive procedure to strengthen corneal tissue and stabilize the cornea’s shape.

If you have been diagnosed with keratoconus, or if you are concerned that your condition might be deteriorating, contact Dr. Shaun Golemba at Scleral Contacts Lens Center At Valley Vision Optometry to evaluate whether CXL is the best option for you.

What Is Corneal Collagen Cross-Linking?

Corneal collagen cross-linking is a surgical procedure performed by a corneal specialist or ophthalmologist to stabilize the shape and firmness of the cornea. By applying riboflavin (vitamin B2) eye drops and ultraviolet light, the surgical treatment promotes the building of new collagen fiber links within the cornea. In many cases, it helps prevent the need for a corneal transplant.

Collagen plays a vital role in creating and maintaining the smooth round shape of the eye’s surface. The tightness of the woven collagen fibers determines the strength of the corneal tissue. A weak cornea is prone to deformation, causing keratoconus to progress.

CXL is also effective in treating corneal ulcers in cases where topical antibiotics did not produce results. Several other corneal infections have also successfully been treated with CXL.

Your Optometrist Prepares You for CXL

A few steps need to be taken before you undergo corneal collagen cross-linking. Dr. Shaun Golemba can assess whether you are a candidate and get you ready for the surgical procedure.

1) We’ll Evaluate If You Need CXL

At Scleral Contacts Lens Center At Valley Vision Optometry, we will inquire into your patient history to determine whether any previous eye surgeries might prevent you from undergoing CXL. We will also examine several other factors, such as keratoconus progression and corneal thickness. In case you have dry eye, this needs to be treated appropriately before scheduling the CXL procedure.

2) Connecting You With The Right Surgeon

Following your eye exam and the evaluation of your suitability for CXL, we will connect you with an ophthalmologist to schedule the actual procedure. We at Scleral Contacts Lens Center At Valley Vision Optometry work with the finest corneal specialists in the area because we want you to be in good hands.

3) Pre-Op Exam With Your Optometrist

Just before the surgery, you will have a short pre-op examination at Scleral Contacts Lens Center At Valley Vision Optometry. Lens wearers are required to remove their contact lenses a few days prior to this examination so that measurements can be entirely accurate.

Dr. Shaun Golemba will gather measurements about visual acuity, refraction, the shape of the corneal surface, and intraocular pressure. The data generated in this examination will be used for comparison in every future examination, and provide background for follow-up should the keratoconus continue to progress after the surgical intervention.

The CXL Procedure

seniors smiling 2 640The ophthalmologist will first apply riboflavin eye drops (vitamin B2) to the surface of the eye. This substance is conducive to photo-enhancing; in other words, it improves light absorption. Next, the practitioner will expose the eye to a specific ultraviolet light to activate the development of new collagen cross-linking. This will cause the collagen fiber to thicken across the entire cornea and reinforce it.

There are two types of corneal cross-linking procedures:

  • Epithelium-on cross-linking or transepithelial cross-linking. In this procedure, the doctor applies the eye drops onto the outer layer of the cornea, called the epithelium.
  • Epithelium-off cross-linking. To allow the riboflavin to penetrate more easily into the lower layers of the cornea, the doctor removes its outer layer before applying the drops. This surgical intervention has a slightly higher risk, as it could cause the disruption of surface cells in the epithelium.

We Provide Post-Op Care

The success of the one-hour surgical treatment depends as much on the quality of postoperative care as it does on the procedure itself. Careful management of eye health is essential for rapid rehabilitation of visual clarity and to reduce the risk of complications.

Follow-up care provided at Scleral Contacts Lens Center At Valley Vision Optometry includes three main objectives, of which the speedy healing of the corneal surface is primary. Generally, patients are prescribed temporary soft contact lenses to protect the eye surface during the healing process. The lenses also serve the purpose of minimizing potential pain.

To prevent infections, Dr. Shaun Golemba will provide topical antibiotics and other medications that may be needed to protect the cornea and ensure a safe and fast recovery.

Who Can Undergo Corneal Collagen Cross-Linking?

The surgical treatment is recommended for patients who have recently been diagnosed with keratoconus and patients with a rapidly worsening condition. The sooner the treatment is applied, the better the chances of strengthening the cornea or even improving its shape.

Because CXL does not restore lost vision, early treatment is critical to prevent visual acuity from declining. This can also increase the chances of wearing traditional contact lenses later on.

Patients with stable keratoconus, a thin cornea, or a scarred cornea may not benefit from CXL and can potentially delay or avoid the procedure altogether.

Contact Dr. Shaun Golemba at Scleral Contacts Lens Center At Valley Vision Optometry for additional information or to schedule an eye exam.

Scleral Contacts Lens Center At Valley Vision Optometry serves patients from Vancouver Island, Lower Mainland, Okanagan, Kootenay’s, and throughout British Columbia.

 

 

Resources:

https://www.allaboutvision.com/conditions/corneal-crosslinking.htm

https://eyewiki.aao.org/Corneal_Collagen_Cross-Linking

https://www.allaboutvision.com/conditions/keratoconus.htm

https://www.nkcf.org/corneal-cross-linking-are-you-a-good-candidate/

https://www.eyeworld.org/article-postoperative-management-of-corneal

https://crstoday.com/articles/2017-jul/simplifying-the-preoperative-evaluation/

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We are currently offering in-office care by appointment only.

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COVID-19 UPDATE

The following is a summary of the steps we have taken to protect your safety.

Physical Distancing Measures:

o Reducing density of people: We have adopted a schedule which will reduce the amount of patients in our facility at one time.

o We will have some of our team working from home operating a call centre and tele-medicine pre-screening.

o Spacing stickers have been placed on our floor.

Engineering controls:

o Forms have been digitized and will be emailed to patients in advance of the appointment to minimize contact.

o A “For Payment" button has been installed on our website, valleyvisionoptometry.ca for patients to be able to pay from home to minimize contact.

o Plexiglass barriers have been installed at all 3 Front Desk stations

o Our doors will remain locked during Phase 2, opening the door to let in scheduled patients only.

o A dropbox has been installed for patients to drop off glasses in need of repair.

o Contact lens sales are administered through our webstore.

Administrative controls:

o Cleaning protocols have been written. Staff training on these protocols has been scheduled.

o Clear rules are posted on our front door and throughout all of the stations in our office.

Personal protective equipment:

o Patients will be required to wear a mask upon entry to the office and throughout their time with us. Those who do not have a mask will be supplied a surgical mask upon entry.

Policies around sickness:

o Employees and patients with cold or flu symptoms will be required to stay home.

Frequent hand washing:

o Patients, Doctors, and our Team will be required to wash hands upon entry and exit in to the exam rooms.

o Eyewear Consultants will wear gloves when handling eyewear and performing adjustments.

We currently are operating a reduced schedule, so are triaging patients to ensure those with the highest needs are prioritized.

Sincerely,

Dr. Shaun Golemba

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We are open by appointment only. Our current hours are Monday to Friday, 8am – 4pm. Please call our office to schedule an appointment. Read about our safety protocols here.